efile Public Visual Render
ObjectId: 201923179349303592 - Submission: 2019-11-13
TIN: 20-1615393
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
18
Open to Public Inspection
Name of the organization
MONTEFIORE HEALTH SYSTEM INC
Employer identification number
20-1615393
Part I
Identification of Disregarded Entities
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
(1)
Montefiore SS Holdings LLC
111 East 210th Street
Bronx
,
NY
10467
32-0412092
Holding Comp
NY
3,623,304
30,324,289
MHS
(2)
Montefiore MV Holdings LLC
111 East 210th Street
Bronx
,
NY
10467
35-2478922
Holding Comp
NY
857,478
10,078,452
MHS
(3)
Montefiore HA Holdings LLC
111 East 210th Street
Bronx
,
NY
10467
90-0995466
Holding Comp
NY
493,724
4,970,956
MHS
(4)
Montefiore HMO LLC
111 East 210th Street
Bronx
,
NY
10467
38-3880401
Managed Care
NY
382,741
44,812,760
MHS
(5)
Montefiore Information Technology LLC
3 Odell Plaza
Yonkers
,
NY
10701
13-4179243
IT
NY
126,967,118
22,973,516
MHS
Part II
Identification of Related Tax-Exempt Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
Montefiore Medical Center
111 East 210th Street
Bronx
,
NY
10467
13-1740114
ACD MED CTR
NY
501(c)(3)
3
MHS
Yes
(2)
MMC Corporation
111 East 210th Street
Bronx
,
NY
10467
13-3430322
Real Estate
NY
501(c)(3)
12A type I
MMC
Yes
(3)
MMC Residential Corp I Inc
3411 Wayne Avenue
Bronx
,
NY
10467
91-1943271
Staff Housing
NY
501(c)(2)
MMC
Yes
(4)
Montefiore Hosp Housing Section II Inc
3450 Wayne Avenue
Bronx
,
NY
10467
23-7160641
Staff Housing
NY
501(c)(2)
MMC
Yes
(5)
Mosholu Preservation Corporation
3400 Resevoir Oval East
Bronx
,
NY
10467
13-3109387
Community Ser
NY
501(c)(3)
12A Type I
MMC
Yes
(6)
Gun Hill MRI PC
200 East Gun Hill Road
Bronx
,
NY
10467
13-3734486
Diag Services
NY
501(c)(3)
12A Type I
MMC
Yes
(7)
Montefiore New Rochelle Hospital
16 Guion Place
New Rochelle
,
NY
10801
46-2931956
Hospital
NY
501(c)(3)
3
MHS
Yes
(8)
Montefiore Mount Vernon Hospital
12 North Seventh Avenue
Mount Vernon
,
NY
10550
46-2916938
Hospital
NY
501(c)(3)
3
MHS
Yes
(9)
Schaffer Extended Care Center
16 Guion Place
New Rochelle
,
NY
10801
46-2929888
Nursing Home
NY
501(c)(3)
3
MHS
Yes
(10)
Montefiore Foundation Inc
111 East 210th Street
Bronx
,
NY
10467
47-1600439
Inactive
NY
501(c)(3)
7
MMAHS
Yes
(11)
Albert Einstein College OF MEDICINE INC
1300 Morris Park Avenue
Bronx
,
NY
10461
47-2209056
Med College
NY
501(c)(3)
2
MMAHS
Yes
(12)
Montefiore Medicine ACADEMIC HEALTH SYST
555 South Broadway BLDG A FL 1
Tarrytown
,
NY
10591
47-1582973
Sys Parent
NY
501(c)(3)
12B Type II
NA
Yes
(13)
Montefiore Nyack Hospital
160 North Midland Avenue
Nyack
,
NY
10960
13-1740119
Hospital
NY
501(c)(3)
3
MHS
Yes
(14)
White Plains Hospital Medical Center
41 East Post Road
White Plains
,
NY
10601
13-1740130
hospital
NY
501(c)(3)
3
MHS
Yes
(15)
AECOM Student Housing Co Inc
1300 Morris Park Avenue
Bronx
,
NY
10461
23-7075620
student hous
NY
501(c)(2)
AECOM
Yes
(16)
Montefiore CERC Operations Inc
111 East 210th Street
Bronx
,
NY
10467
47-4853506
Rehab center
NY
501(C)(3)
3
MMC
Yes
(17)
White Plains Hospital Ctr FoundationInc
41 East Post Rd Davis Ave
White Plains
,
NY
10601
13-3281507
Fundraising
NY
501(c)(3)
12A type I
WPHMC
Yes
(18)
Nyack Hospital Foundation
160 North Midland Avenue
Nyack
,
NY
10960
13-3245804
FUNDRAISING
NY
501(c)(3)
7
Nyack Hosp
Yes
(19)
The Winifred Masterson Burke Rehab Hosp
785 Mamaroneck Avenue
White Plains
,
NY
10605
13-1739937
Rehab Hosp
NY
501(c)(3)
3
MHS
Yes
(20)
St Luke's Cornwall Hospital
70 Dubois Street
Newburgh
,
NY
12550
14-1340054
Hospital
NY
501(c)(3)
3
mhs
Yes
(21)
Hudson Vista Medical PC
70 Dubois Street
Newburgh
,
NY
12550
45-2526738
Healthcare
NY
501(c)(3)
12A Type I
SLCH
Yes
(22)
Hudson Vista Physician Services PC
70 Dubois Street
Newburgh
,
NY
12550
27-2020746
Healthcare
NY
501(c)(3)
12A Type I
SLCH
Yes
(23)
St Luke's Cornwall Health System Inc
70 Dubois Street
Newburgh
,
NY
12550
22-3026261
Holding Comp
NY
501(c)(3)
12A Type I
MHS
Yes
(24)
St Luke's Cornwall Health SYSTEM FDN
70 Dubois Street
Newburgh
,
NY
12550
22-3026263
Fundraising
NY
501(c)(3)
7
SLCHS
Yes
(25)
Amos and Sarah Holden Home
70 Dubois Street
Newburgh
,
NY
12550
14-1365995
Asst Living
NY
501(c)(3)
PF
SLCHS
Yes
(26)
Goldsmith D and Mary B Johnes Home
70 Dubois Street
Newburgh
,
NY
12550
14-1364666
Home for Aged
NY
501(c)(3)
10
SLCHS
Yes
(27)
MONTEFIORE MED ACAD HLTH SYS SELF INS TR
555 SOUTH BROADWAY
TARRYTOWN
,
NY
105916301
82-4019223
INS TRUST
NY
501(C)(3)
12A TYPE I
MMAHS
Yes
(28)
ALBERT EINSTEIN COLLEGE OF MEDICINE
1300 MORRIS PARK AVENUE
BRONX
,
NY
104611975
83-0621846
MED COLLEGE
NY
501(C)(3)
2
MMAHS
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2018
Page 2
Schedule R (Form 990) 2018
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
University Behavioral Associates Inc
111 East 210th Street
Bronx
,
NY
10467
13-3877781
Mgmt Services
NY
na
C Corp
Yes
(2)
The Montefiore IPA Inc
111 East 210th Street
Bronx
,
NY
10467
13-4114915
Integ Provr Assoc
NY
na
C Corp
Yes
(3)
MMC GI Holdings East Inc
111 East 210th Street
Bronx
,
NY
10467
72-1610013
Holding Company
NY
na
C Corp
Yes
(4)
MMC GI Holdings West Inc
111 East 210th Street
Bronx
,
NY
10467
72-1610015
Holding Company
NY
na
C Corp
Yes
(5)
Montefiore Behavioral Care IPA NO 1 Inc
111 East 210th Street
Bronx
,
NY
10467
13-3952750
Integ Provr Assoc
NY
na
C Corp
Yes
(6)
Bronx Accountable Care Network IPA Inc
111 East 210th Street
Bronx
,
NY
10467
30-0689571
Integ Provr Assoc
NY
na
C Corp
Yes
(7)
Montefiore Consolidated Ventures Inc
111 East 210th Street
Bronx
,
NY
10467
61-1728539
Holding Company
NY
MHS
C Corp
Yes
(8)
Montefiore Insurance Company Inc
111 East 210th Street
Bronx
,
NY
10467
32-0436594
Inactive
NY
MHS
C Corp
Yes
(9)
Hudson Valley IPA Inc
111 East 210th Street
Bronx
,
NY
10467
38-3978087
integ provr assoc
NY
na
c corp
Yes
(10)
Montefiore Innovations Inc
111 East 210th Street
Bronx
,
NY
10467
47-5106910
holding company
NY
na
C corp
Yes
(11)
HIGHLAND MEDICAL PC
160 NORTH MIDLAND AVENUE
NYACK
,
NY
10960
13-4034481
Healthcare Serv
NY
na
C CORP
Yes
(12)
8 LONGVIEW DEVELOPMENT CORP
DAVIS AVENUE AT EAST POST ROAD
WHITE PLAINS
,
NY
10601
26-3321278
HOUSING
NY
na
C CORP
Yes
(13)
WHITE PLAINS MEDICAL DIAGNOSTIC SVCS PC
41 EAST POST ROAD
WHITE PLAINS
,
NY
10601
45-3164626
Healthcare Serv
NY
na
C CORP
Yes
(14)
CANCER AND BLOOD MEDICAL SERVICES OF NY
41 EAST POST ROAD
WHITE PLAINS
,
NY
10601
46-2021804
Healthcare Serv
NY
na
C CORP
Yes
(15)
DAVIS AVENUE CORP
DAVIS AVENUE AT EAST POST ROAD
WHITE PLAINS
,
NY
10601
13-3331643
Inactive
NY
na
C CORP
Yes
(16)
WHITE PLAINS MANAGEMENT CO INC
41 EAST POST ROAD
WHITE PLAINS
,
NY
10601
13-3331641
Inactive
NY
na
C CORP
Yes
(17)
WPHC BUILDINGS CORP
41 EAST POST ROAD
WHITE PLAINS
,
NY
10601
13-3676932
Inactive
NY
na
C CORP
Yes
(18)
White Plains Medical Services PC
Davis Avenue at East Post Road
White Plains
,
NY
10601
81-5369152
Healthcare Serv
NY
na
C Corp
Yes
(19)
White Plains Physician Services PC
Davis Avenue at East Post Road
White Plains
,
NY
10601
81-5309615
Inactive
NY
na
C Corp
Yes
(20)
Charitable Remainder Trust (5)
Charit Remr Trust
NY
na
Trust
Yes
(21)
CRHT ACQUISITION INC
555 SOUTH BROADWAY BLDG A FL 1
TARRYTOWN
,
NY
10591
81-5220651
HOLDING COMPANY
NY
NA
C CORP
Yes
(22)
QUANTUM BIOTHERAPEUTICS LLC
111 EAST 210TH STREET
BRONX
,
NY
10467
61-1793667
INACTIVE
NY
NA
C CORP
Yes
(23)
WHITE PLAINS PHYSICIAN MEDICAL SERV PC
DAVIS AVENUE AT EAST POST ROAD
WHITE PLAINS
,
NY
10601
83-0519787
INACTIVE
NY
NA
C CORP
Yes
(24)
EAST POST ROAD MEDICAL SERVICES INC PC
DAVIS AVENUE AT EAST POST ROAD
WHITE PLAINS
,
NY
10601
83-0535258
INACTIVE
NY
NA
C CORP
Yes
(25)
EAST POST ROAD PHYSICIAN SERV PC
DAVIS AVENUE AT EAST POST ROAD
WHITE PLAINS
,
NY
10601
83-0563325
INACTIVE
NY
NA
C CORP
Yes
(26)
DAVIS AVENUE MEDICAL SERVICES PC
DAVIS AVENUE AT EAST POST ROAD
WHITE PLAINS
,
NY
10601
83-0579310
INACTIVE
NY
NA
C CORP
Yes
(27)
WPH HOLDING COMPANY
DAVIS AVENUE AT EAST POST ROAD
WHITE PLAINS
,
NY
10601
83-3893119
holding company
NY
NA
C CORP
Yes
Schedule R (Form 990) 2018
Page 3
Schedule R (Form 990) 2018
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
Yes
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
Yes
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
MONTEFIORE MEDICAL CENTER
L
129,937,959
COST
(2)
MONTEFIORE NEW ROCHELLE HOSPITAL
J
3,623,304
COST
(3)
MONTEFIORE MOUNT VERNON HOSPITAL
J
857,478
COST
(4)
SCHAFFER EXTENDED CARE CENTER
J
493,724
COST
(5)
MONTEFIORE MEDICAL CENTER
M
12,669,596
COST
(6)
MONTEFIORE MEDICAL CENTER
P
7,185,759
COST
(7)
MONTEFIORE NEW ROCHELLE HOSPITAL
L
2,530,265
COST
(8)
MONTEFIORE MOUNT VERNON HOSPITAL
L
1,258,399
COST
(9)
SCHAFFER EXTENDED CARE CENTER
L
70,628
COST
(10)
MONTEFIORE NEW ROCHELLE HOSPITAL
A
1,871,134
COST
(11)
MONTEFIORE MOUNT VERNON HOSPITAL
A
784,068
COST
(12)
SCHAFFER EXTENDED CARE CENTER
A
409,418
COST
(13)
MONTEFIORE MEDICAL CENTER
R
2,152,535
COST
(14)
The Winifred Masterson Burke Rehab Hosp
L
2,632,463
COST
(15)
Montefiore NYACK HOSPITAL
L
439,088
COST
(16)
WHITE PLAINS HOSPITAL MEDICAL CENTER
L
6,029,631
COST
(17)
ALBERT EINSTEIN COLLEGE OF MEDICINE INC
L
2,232,248
COST
(18)
St Luke's Cornwall Hospital
L
867,074
cost
(19)
MONTEFIORE MEDICAL CENTER
q
6,019,087
COST
(20)
Montefiore Medical Center
K
258,534
cost
(21)
Montefiore Mount Vernon Hospital
D
2,990,004
cost
(22)
Montefiore Medical Center
S
30,578,596
cost
(23)
Albert Einstein Coll of Med Student Housing
Q
64,000
cost
(24)
Montefiore Medicine Academic Hlth System Inc
P
643,739
cost
Schedule R (Form 990) 2018
Page 4
Schedule R (Form 990) 2018
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2018
Page 5
Schedule R (Form 990) 2018
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2018
Additional Data
Software ID:
Software Version: